The burden of stroke continues to disproportionately impact the Southeast United States ? the so-called Stroke Belt. Reaching these populations for stroke education, prevention, acute treatment, rehabilitation, and in particular participation in clinical research, remains a challenge. Developing a highly functional clinical and research multicenter infrastructure to engage these populations at high risk for stroke is critical to change the disproportionate stroke burden. Stroke care and research, from prevention, through acute treatment, and finally through recovery / rehabilitation, are best provided and performed in the context of multidisciplinary healthcare teams. Stroke Systems of Care, integrating healthcare resources across a geographic region, are recognized as best practice, ensuring optimal care within the region. Research is also best performed working within the existing clinical stroke systems of care, capitalizing on areas of alignment ? patient education, engagement, stroke awareness in the healthcare community, and awareness of research participation opportunities in all healthcare settings. In this application, the expanded Southeast Collaborative Alliance for Stroke Trials (SE-CoAST) and its investigators remain committed to serving as a Regional Coordinating Center in StrokeNet. SE-CoAST is now an expanded, robust collaboration between 4 tertiary care academic medical centers situated in the heart of the Stroke Belt: the Medical University of South Carolina along the SC coast, the Augusta University in eastern GA, the Greenville Heath System in the upstate of SC, and the Palmetto Health / University of South Carolina Health System in the midlands of SC. The greatest strength of this expanded network is our existing partnerships in research and stroke care delivery. SE-CoAST now serves nearly the entire state of SC and a large proportion of GA, given the breadth of our catchment areas as well as our significant telestroke presence across the Southeast. The overall goals of SE-CoAST remain: 1) to leverage the SE-CoAST organization to increase the number of residents of our states participating in acute, prevention and recovery StrokeNet trials; 2) to continue our leadership roles in StrokeNet activities nationally; 3) to utilize SE-CoAST preclinical researchers in developing promising therapeutic interventions for study within StrokeNet; 4) to continue to support and enhance the career development of our StrokeNet scholars.